Trends in renal failure-related mortality among U.S. multiple myeloma patients aged ≥ 45 years, 1999-2023: analysis
Ye Jiang1, Zhichao Meng1, Guanghua Liang1
1Department of Orthopedics, Peking University First Hospital, Beijing, People's Republic of China.
Abstract:
Multiple myeloma (MM) is a plasma cell malignancy frequently complicated by renal impairment, which substantially worsens prognosis. Although therapeutic advances have improved MM survival, renal failure remains a major contributor to adverse outcomes. This study examined long-term trends and demographic disparities in mortality among U.S. decedents with MM listed as the underlying cause of death and renal failure listed as a contributing cause. Mortality data for adults aged ≥ 45 years from 1999 to 2023 were obtained from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) database. Deaths were identified using ICD-10 codes, with MM (C90.0) as the underlying cause and renal failure (N17-N19) as a contributing cause. Age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) were calculated by sex, race/ethnicity, region, age group, and urbanization level. Temporal trends were evaluated using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Overall mortality declined from 1999 to 2023, with the AAMR decreasing from 2.39 to 1.60 per 100,000 population (AAPC: -1.30). Despite this improvement, substantial disparities persisted. Males consistently exhibited higher AAMRs than females. Non-Hispanic Black individuals had the highest race-specific mortality rates. Residents of nonmetropolitan areas and those living in the Midwest experienced persistently higher mortality. Age-stratified analyses showed declining trends in most age groups, while adults aged ≥ 85 years demonstrated a modest recent increase. Mortality among U.S. adults with MM listed as the underlying cause of death and renal failure as a contributing cause declined between 1999 and 2023. However, persistent disparities by sex, race/ethnicity, region, urbanization, and age remain. These findings highlight the need for targeted strategies to reduce the burden of renal complications among high-risk MM populations.
Insights
Mortality for multiple myeloma (MM) with renal failure declined overall from 1999-2023, but significant disparities persist for males, Black individuals, and those in nonmetropolitan areas. Targeted strategies are needed to address these persistent health inequities.
Area of Science:
- Hematology and Oncology
- Nephrology and Urology
- Public Health and Epidemiology
Background:
- Multiple myeloma (MM) is a plasma cell malignancy often complicated by renal impairment, significantly worsening prognosis.
- Despite advances in MM treatment, renal failure remains a critical factor in adverse patient outcomes.
- Understanding long-term mortality trends and demographic disparities in MM with renal failure is crucial for public health interventions.
Purpose of the Study:
- To examine long-term trends in mortality among U.S. adults with multiple myeloma (MM) and renal failure as a contributing cause of death.
- To identify and analyze demographic disparities in mortality rates based on sex, race/ethnicity, region, age, and urbanization level.
- To evaluate the impact of renal complications on overall survival in the MM population.
Main Methods:
- Utilized mortality data from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) database for adults aged ≥45 years (1999-2023).
- Identified deaths with MM (ICD-10 code C90.0) as the underlying cause and renal failure (ICD-10 codes N17-N19) as a contributing cause.
- Calculated age-adjusted mortality rates (AAMRs) and employed Joinpoint regression to analyze temporal trends and disparities across demographic groups.
Main Results:
- Overall age-adjusted mortality rates for MM with renal failure declined from 2.39 to 1.60 per 100,000 population between 1999 and 2023 (AAPC: -1.30%).
- Persistent disparities were observed: males had higher AAMRs than females, Non-Hispanic Black individuals exhibited the highest rates, and residents of nonmetropolitan areas and the Midwest faced higher mortality.
- While most age groups showed declining trends, adults aged ≥85 years experienced a modest recent increase in mortality.
Conclusions:
- Mortality associated with multiple myeloma and renal failure has decreased in the U.S. from 1999 to 2023.
- Significant and persistent disparities in mortality exist across sex, race/ethnicity, geographic region, urbanization, and age groups.
- Targeted strategies are essential to mitigate the impact of renal complications and reduce health inequities in high-risk multiple myeloma populations.
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